Most patients don't experience acute kidney
problems beforehand
Newswise, March 9, 2017 — Taking popular heartburn drugs for
prolonged periods has been linked to serious kidney problems, including kidney
failure. The sudden onset of kidney problems often serves as a red flag for
doctors to discontinue their patients’ use of so-called proton pump inhibitors
(PPIs), which are sold under the brand names Prevacid, Prilosec, Nexium and
Protonix, among others.
But a new study evaluating the use of PPIs in 125,000 patients
indicates that more than half of patients who develop chronic kidney damage
while taking the drugs don’t experience acute kidney problems beforehand,
meaning patients may not be aware of a decline in kidney function, according to
researchers at Washington University School of Medicine in St. Louis and the
Veterans Affairs St. Louis Health Care System.
Therefore, people who take PPIs, and their doctors, should be
more vigilant in monitoring use of these medications.
The study is published in Kidney International.
“The onset of acute kidney problems is not a reliable warning
sign for clinicians to detect a decline in kidney function among patients
taking proton pump inhibitors,” said Ziyad Al-Aly, MD, the study’s senior
author and an assistant professor of medicine at Washington University School
of Medicine.
“Our results indicate
kidney problems can develop silently and gradually over time, eroding kidney
function and leading to long-term kidney damage or even renal failure. Patients
should be cautioned to tell their doctors if they’re taking PPIs and only use
the drugs when necessary.”
More than 15 million Americans suffering from heartburn,
ulcers and acid reflux have prescriptions for PPIs, which bring relief by
reducing gastric acid. Many millions more purchase the drugs over-the-counter
and take them without being under a doctor’s care.
The researchers — including first author Yan Xie, a
biostatistician at the St. Louis VA —analyzed data from the Department of
Veterans Affairs databases on 125,596 new users of PPIs and 18,436 new users of
other heartburn drugs referred to as H2 blockers. The latter are much less
likely to cause kidney problems but often aren’t as effective.
Over five years of follow up, the researchers found that more
than 80 percent of PPI users did not develop acute kidney problems, which often
are reversible and are characterized by too little urine leaving the body,
fatigue and swelling in the legs and ankles.
However, more than half of the cases of chronic kidney damage
and end-stage renal disease associated with PPI use occurred in people without
acute kidney problems.
In contrast, among new users of H2 blockers, 7.67 percent
developed chronic kidney disease in the absence of acute kidney problems, and
1.27 percent developed end-stage renal disease.
End-stage renal disease occurs when the kidneys can no longer
effectively remove waste from the body. In such cases, dialysis or a kidney
transplant is needed to keep patients alive.
“Doctors must pay careful attention to kidney function in
their patients who use PPIs, even when there are no signs of problems,”
cautioned Al-Aly, who also is the VA’s associate chief of staff for research
and education and co-director of the VA’s Clinical Epidemiology Center.
“In general, we always
advise clinicians to evaluate whether PPI use is medically necessary in the
first place because the drugs carry significant risks, including a
deterioration of kidney function.”
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